Provider Demographics
NPI:1245580109
Name:NORTH FLORIDA PLASTIC SURGERY PLLC
Entity Type:Organization
Organization Name:NORTH FLORIDA PLASTIC SURGERY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:W
Authorized Official - Last Name:TYRONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-332-1150
Mailing Address - Street 1:108 NW 76TH DR
Mailing Address - Street 2:STE A
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-6652
Mailing Address - Country:US
Mailing Address - Phone:352-332-1150
Mailing Address - Fax:
Practice Address - Street 1:108 NW 76TH DR
Practice Address - Street 2:STE A
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-6652
Practice Address - Country:US
Practice Address - Phone:352-332-1150
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-18
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4901183261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty